Will some areas be impossible to bid?
PHILADELPHIA - State lines might just be marks on a map to CMS, but for providers looking to bid in the Philadelphia competitive bidding area (CBA), they're presenting real boundaries.
To submit a bid in the Philadelphia CBA, providers will need to meet state licensure requirements in not only Pennsylvania but also Delaware, Maryland and New Jersey. The Allentown CBA also includes part of New Jersey. Providing HME across state lines means providers need to learn the nuances of each state's programs, said John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers.
"If you've seen one Medicaid program...you've seen only one Medicaid program," said Shirvinsky. "By forcing these very large interstate bidding areas, they're creating very unnecessary problems."
One of those problems: The state of Maryland requires a business license, a process that typically takes six months and costs a nonrefundable $500, according to Shirvinsky. Getting through that process before bidding is scheduled to open in the winter of 2012 may be difficult for providers, he said.
Another problem: New Jersey has a moratorium on new HME providers entering the Medicaid program.
"Non-New Jersey providers are at a distinct disadvantage in that they will be unable to serve the dual eligible population, which is significant," said Shirvinsky.
This could even bar non-New Jersey providers from submitting a bid, since all bid winners must be able to serve all Medicare recipients within the entire CBA, Shirvinsky said.
"So the question is, if I cannot bill dual eligibles in New Jersey, am I even eligible to bid?" he said.
Also in New Jersey: There's a requirement that a provider employ a licensed respiratory therapist to visit a patient within 24 hours of oxygen equipment being dropped off.
Providers who plan to bid in the Pennsylvania CBAs are working to meet each state's requirements. Provider Bill Bayer is already licensed to do business in New Jersey, as Bristol, Pa.-based Medical Express is right on the border. He has had to become a licensed RT.
"(The respiratory therapist license) wasn't the easiest license to get as far as the whole application process," said Bayer, who had to fetch his high school transcripts after more than 30 years, despite having bachelor's and master's degrees.
Even without the obstacles presented by each state's requirements, Shirvinsky said the CBAs are too big for an industry made up mostly of small businesses.
"Metropolitan statistical areas are not healthcare markets," said Shirvinsky. "They're a creation of the census bureau and the department of labor and they're for data analysis."